Diabetes Care Professionals Research Articles

The effectiveness of diabetes training of psychiatric health professionals on individuals with diabetes and psychiatric disorders – a pragmatic controlled trial in Denmark

BackgroundIndividuals with diabetes and co-existing psychiatric disorders have more diabetes complications and lower life expectancy than those with diabetes but no co-existing psychiatric disorders. Psychiatric health professionals may have a role in improving these outcomes but often lack diabetes knowledge and skills. This study aims to examine the effectiveness of a diabetes training course for psychiatric health professionals on their diabetes knowledge and skills and clinical outcomes, diabetes support and diabetes distress among individuals with diabetes and psychiatric disorders treated in psychiatric outpatient clinics.MethodsA pragmatic non-randomized controlled cluster trial was conducted in eight psychiatric outpatient clinics in Denmark. All psychiatric health professionals from four clinics participated in the diabetes training course (the intervention) and completed a questionnaire on experience of the training course and a 20-item pre- and post-test to measure diabetes knowledge and skills. Difference in pre- and post-tests were analyzed using t-tests. From August 2018 – June 2019, individuals with diabetes were recruited from the intervention clinics (n = 49) and from four control clinics continuing usual clinical practice (n = 57). Differences in clinical outcomes, diabetes support and diabetes distress between the intervention and control groups at six and 12 months after the training course, were analyzed using logistic and linear regression models adjusted for baseline levels.ResultsPsychiatric health professionals (n = 64) had more correct answers after completing the course, with a mean increase of 6.3 [95% CI 5.6 to 7.0] correct answers. A total of 49 and 57 individuals were recruited for the intervention and control group, respectively. At follow-up, individuals treated in the intervention group had lower levels (clinical improvement) of systolic blood pressure, but had lower receipt of annual assessment of blood pressure, and body mass index (BMI) (worsening of process measures). While there were observed differences in odds and means for several other outcomes, none of these received statistical significance (see Table 2 and Fig. 2).ConclusionsTraining psychiatric health professionals in diabetes care improved their diabetes knowledge and skills and improved clinical levels of systolic blood pressure in individuals treated in the intervention group. However, this training intervention was associated with a lower likelihood of receiving annual assessment of blood pressure and BMI.Trial registrationISRCTN registry registration number ISRCTN15523920, registration date: 02/10/2019.

Self-Care of Diabetes and Diabetes Distress in Non-Hispanic Black Adults With Type 2 Diabetes.

The purpose of the study was to describe the level of self-care of diabetes and diabetes distress and examine their relationship in non-Hispanic Black adults living with type 2 diabetes. This cross-sectional, correlational study was conducted with 275 non-Hispanic Black adults with type 2 diabetes in North Carolina over 10 weeks, July 2022 to September 2022. An online survey collected sociodemographic and clinical characteristics, self-care measures of diabetes, and diabetes distress. The theory of self-care of chronic illness guided the study. Median regression examined the relationship between self-care of diabetes and diabetes distress. Of the 275 participants, over half reported a diagnosis of type 2 diabetes at younger ages than expected, with a mean age of 40. The self-reported mean A1C of 9% exceeded the recommended goal of <7%, with an average of 2 diabetes-related comorbidities. The self-care of diabetes scale scores were low, and total diabetes distress scores were high. Significant positive associations were found between total diabetes distress and self-care monitoring and self-care management. In this sample, non-Hispanic Black adults had low levels of self-care of diabetes and high levels of diabetes distress. The findings indicate a relationship between self-care of diabetes and diabetes distress; as diabetes distress increases, so do the attempted activities of self-care of diabetes. Health care professionals in diabetes care are uniquely positioned to address further the behavioral aspects of diabetes management, particularly diabetes distress, to support non-Hispanic Black adults living with type 2 diabetes.

Call for Cultural and Language-Concordant Diabetes Care, Nutrition Education, and Self-Management for South Asian Individuals Living in the US

Ethnic South Asian Americans have the highest relative risk of type 2 diabetes mellitus in the US. Culturally tailored and language-concordant diabetes care and nutrition interventions can potentially promote South Asian diabetes management and disease progression. From our perspective, the extent of their use and evaluation in the US settings remains limited. This Perspective characterizes and evaluates the necessity and outcomes of culturally and linguistically adapted lifestyle interventions targeted toward type 2 diabetes mellitus indicators among South Asian individuals in the US. Suggestions for how this education could be modified include emphasizing the cultural and linguistic knowledge and self-awareness of diabetes educators and the sociological and historical factors that influence the cultural and linguistic orientation of diabetes care professionals and their clients. Such strategies could ensure better diabetes education and self-management among South Asian individuals.

The magnitude of chronic diabetes complications and its associated factors among diabetic patients attending the general hospitals in Tigray region, Northern Ethiopia.

Diabetes is a severe challenge to global public health since it is a leading cause of morbidity, mortality, and rising healthcare costs. 3.0 million Ethiopians, or 4.7% of the population, had diabetes in 2021. Studies on the chronic complications of diabetes in Ethiopia have not been conducted in lower-level healthcare facilities, so the findings from tertiary hospitals do not accurately reflect the issues with chronic diabetes in general hospitals. In addition, there is a lack of information and little research on the complications of chronic diabetes in Ethiopia. The objective of this study was to assess the degree of chronic diabetes complications and associated factors among diabetic patients presenting to general hospitals in the Tigray area in northern Ethiopia. As part of a multi-centre cross-sectional study, 1,158 type 2 diabetes (T2D) patients from 10 general hospitals in the Tigray region were randomly chosen. An interviewer-administered questionnaire, a record review, and an SPSS version 20 analysis were used to collect the data. All continuous data were presented as mean standard deviation (SD), while categorical data were identified by frequencies. Using a multivariable logistic regression model, the factors associated with chronic diabetes complications among T2D diabetic patients were found, and linked factors were declared at p 0.05. Fifty-four of people with diabetes have chronic problems. Hypertension (27%) eye illness, renal disease (19.1%), and hypertension (27%) eye disease were the most common long-term effects of diabetes. Patients with chronic diabetes complications were more likely to be older than 60, taking insulin and an OHGA (Oral Hyperglycemic Agent) (AOR = 3.00; 95% CI 1.73, 5.26), having diabetes for more than five years, taking more than four tablets per day (AOR = 1.63; 95% CI 1.23,2.15), and having high systolic and diastolic blood pressure. Patients with government employment (AOR = 0.48; 95% CI 0.26, 0.90), antiplatelet drug use (AOR = 0.29; 95% CI 0.16, 0.52), and medication for treating dyslipidemia (AOR = 0.54; 95% CI 0.35, 0.84), all had a decreased chance of developing a chronic diabetes problem. At least one chronic diabetic complication was present in more than half of the patients in this study. Chronic diabetes problems were related to patients' characteristics like age, occupation, diabetes treatment plan, anti-platelet, anti-dyslipidemia medicine, duration of diabetes, high Systolic BP, high Diastolic BP, and pill burden. To avoid complications from occurring, diabetes care professionals and stakeholders must collaborate to establish appropriate methods, especially for individuals who are more likely to experience diabetic complications.

I have never been invited-A cross-sectional explorative study of family members' experiences of encounters with healthcare professionals in diabetes care.

To explore the experiences of family members of adult persons with type 1 diabetes concerning both the approach of healthcare professionals and feelings of alienation in encounters with professional diabetes care. A cross-sectional explorative quantitative and qualitative design. The Family Involvement and Alienation Questionnaire-Revised (FIAQ-R), including an open-ended question, was answered by 37 family members of adult persons with type 1 diabetes. Analyses included descriptive statistics and qualitative analysis. The study has received ethical approval. Family members rated the approach of the healthcare professionals as being somewhat positive and considered that the approach towards them is important. They only felt partially alienated from the professional care. Qualitative data revealed that the family members often lacked direct access to the professional care and that their involvement was dependent on their relationship with the person with diabetes. Findings highlighted that the family members' wish to be involved in the care was sometimes unanswered. Based on the findings, it is reasonable to stress the importance of considering family members' perspectives and involving them in diabetes care to improve overall patient support.

32-LB: Oral Care Behaviors among the U.S. Population with Diabetes

Diabetes self-care skills are necessary to control glucose in people with diabetes (PWD). The ADA recommends self-care behaviors including healthy eating, being active, monitoring, taking medication, consulting diabetes care professionals, and reducing risk for complications. Oral self-care is an important but often overlooked aspect of reducing risk in diabetes self-care. This study examined the relationship between diabetes self-care and oral care behaviors. Using NHANES 2011-2016, we analyzed data from 1,585 dentate adults (≥ 30yrs) with self-reported diabetes. Oral self-care was measured by use of preventive dental care in the past year and flossing frequency (never, 1-6day/week, daily). Descriptive analyses compared people reporting good diabetes self-care (score 4-7, summary score of 7 self-care recommendations) and those with poor diabetes self-care (score 0-3), an approximate median split. Sample weights were applied to derive US population estimates. Multivariable and multinomial logistic regression was performed adjusting for age, gender, race, education, income and health insurance. Among the US PWD, 35% report daily flossing and 29% report never flossing; 48% reported a preventive dental visit in the past year. PWD who performed good diabetes self-care were 47% more likely to report using preventive dental care compared to those with poor diabetes self-care (AOR=1.47, 95%CI 1.18-1.84), and they were 38% more likely to be flossing daily (AOR=1.38, 95%CI 1.07-1.79). PWD who practice good diabetes self-care are more likely to also engage in good oral self-care. However, the association cannot be attributed to diabetes self-management education because until 2023, the ADA standards for diabetes self-management did not address oral health practices or dental care. Continued efforts are needed to incorporate oral self-care practices into diabetes self-care education. Further research is warranted to determine possible disparities in diabetes self-management and oral care. Disclosure Y. Zhang: None. S. Leveille: None. K. Berger: None. S. M. Camhi: None. L. Shi: None.

Development of a tailored intervention targeting sedentary behavior and physical activity in people with stroke and diabetes: A qualitative study using a co-creation framework.

Type 2 diabetes and sedentary behavior pose serious health risks in stroke survivors. Using a co-creation framework, this study aimed to develop an intervention in collaboration with stroke survivors with type 2 diabetes, relatives, and cross-sectoral health care professionals to reduce sedentary behavior and increase physical activity. This qualitative explorative study used a co-creation framework consisting of a workshop and focus group interviews with stroke survivors with type 2 diabetes (n = 3), relative (n = 1), and health care professionals (n = 10) to develop the intervention. A content analysis was used to analyze data. The developed "Everyday Life is Rehabilitation" (ELiR) intervention consisted of a tailored 12-week home-based behavior change intervention with two consultations of action planning, goal setting, motivational interviewing, and fatigue management including education on sedentary behavior, physical activity, and fatigue. The intervention has a minimalistic setup using a double-page paper "Everyday Life is Rehabilitation" (ELiR) instrument making it implementable and tangible. In this study, a theoretical framework was used to develop a tailored 12-week home-based behavior change intervention. Strategies to reduce sedentary behavior and increase physical activity through activities of daily living along with fatigue management in stroke survivors with type 2 diabetes were identified.

The role of artificial intelligence technology in the care of diabetic foot ulcers: the past, the present, and the future.

Foot ulcers are common complications of diabetes mellitus and substantially increase the morbidity and mortality due to this disease. Wound care by regular monitoring of the progress of healing with clinical review of the ulcers, dressing changes, appropriate antibiotic therapy for infection and proper offloading of the ulcer are the cornerstones of the management of foot ulcers. Assessing the progress of foot ulcers can be a challenge for the clinician and patient due to logistic issues such as regular attendance in the clinic. Foot clinics are often busy and because of manpower issues, ulcer reviews can be delayed with detrimental effects on the healing as a result of a lack of appropriate and timely changes in management. Wound photographs have been historically useful to assess the progress of diabetic foot ulcers over the past few decades. Mobile phones with digital cameras have recently revolutionized the capture of foot ulcer images. Patients can send ulcer photographs to diabetes care professionals electronically for remote monitoring, largely avoiding the logistics of patient transport to clinics with a reduction on clinic pressures. Artificial intelligence-based technologies have been developed in recent years to improve this remote monitoring of diabetic foot ulcers with the use of mobile apps. This is expected to make a huge impact on diabetic foot ulcer care with further research and development of more accurate and scientific technologies in future. This clinical update review aims to compile evidence on this hot topic to empower clinicians with the latest developments in the field.

Epidemiological trends in the presentation of diabetic ketoacidosis in children newly diagnosed with type 1 diabetes from 2011 to 2017 in Kuwait.

Monitoring the trends in the presentation of T1D over decades cannot be underestimated as it provides a rich source of information on diabetes-related complications like DKA. DKA represents a medical emergency, with potentially fatal outcome, and thus the prevention of DKA is a priority in diabetes care. The aim of this study is to report on trends in the presentation of DKA in children newly diagnosed with T1D in Kuwait. This study is based on a retrospective review of children newly diagnosed with T1D aged 14 years or less at three Governmental Hospitals representing three health sectors out of the total six health sectors in the country during the period 2011-2017. A total of 799 children (376 males and 423 females) were newly diagnosed with T1D. 287 children presented with DKA (35.9%) with only 73 children (9.1%) classified as severe. During the years 2011 to 2017, we note that the percentage of children older than 6 years of age presenting with severe DKA has decreased significantly (p=0.022). Unfortunately, this has not been replicated in children younger than 6 years. This study highlights the importance of continued monitoring of clinical characteristics of children at diagnosis of T1D specifically presenting with DKA to enable diabetes care professionals to appreciate the multifaceted aspects of T1D, in particular the importance of raising awareness of the early signs of the onset of T1D with special attention to DKA and its severe consequences.

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes.

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes.

Building the 2022 Diabetes Technology Practice Competencies Using Modified Delphi Methodology.

The purpose of this study was to construct professional competencies for diabetes technology use in various care settings reflecting the mission of the Association of Diabetes Care & Education Specialists (ADCES). ADCES convened a core team of nationally representative diabetes technology experts to develop professional competencies specifically related to diabetes technology use. A modified Delphi methodology, which comprised 4 rounds, was used for consensus development among these experts. First, experts developed and arrived at a consensus on the initial draft of competencies. They also identified health care professionals and staff essential for effective technology integration in various diabetes care settings. A survey was completed by diabetes technology experts that are members of ADCES. Next, a multidisciplinary focus group was conducted to gain feedback. Finally, the edited competencies were distributed via survey for feedback by diabetes technology experts from various disciplines. One hundred four diabetes technology experts in the United States participated in the final survey, representing various health care professions and clinical settings. A final set of 94 competencies across 7 domains was determined. Modified Delphi methodology is an effective way to utilize multidisciplinary expertise to develop diabetes technology-related competencies for diabetes care professionals and staff in a variety of settings. These competencies align with the mission of ADCES to empower diabetes care and education specialists to expand the horizons of innovative education, management, and support.

IDF21-0049 ACT NOW a new diabetes foot educational and risk assessment tool for people with diabetes and health care professionals

Background: When a person with diabetes (PwD) develops a foot problem there is often a delay in receiving specialist help, which may result in amputation and health care professionals (HCP) may be accused of medical negligence. Aim: Our aims were to develop an educational tool to recognise the warning signs of foot complications that might lead to amputation and to disseminate the tool and seek endorsement. Method: The delay to specialist help was analysed by the iDEAL group (Insights for Diabetes Excellence, Access and Learning), a multidisciplinary team of diabetes specialists together with a person with diabetes and recommendations were made. Results: An acronym ACT NOW has been devised to act as an educational tool ACT NOW stands for Accident (recent trauma to foot) Change in colour or shape, Temperature change -hot or cold, New pain, Oozing and Wound. The acronym was devised firstly, to help PwD and HCPs recognise the warning signs of foot complications, leading to potential amputation, and secondly, to trigger early and prompt referral to specialist care. On recognising one or more of these features, the PwD can gain confidence, especially during the COVID 19 pandemic, to seek specialist help either directly from a diabetes foot service or through a first contact HCP who can then refer. An ACT NOW tool was also created consisting of the acronym and a a checklist which prompts the PwD, their carers and HCPs to enquire and document the ACT NOW! symptoms or signs and to take possible further information such as a digital photo. The checklist can then be used as a document to facilitate referral to specialist care. Alternatively, the check list can be used when PwDs present for routine assessment with their HCPs. The ACT NOW tool has been disseminated through digital and traditional media and endorsement granted from many organisations, including the IDF. Discussion: Foot ulcers are highly susceptible to infection which can spread rapidly, causing overwhelming tissue destruction or gangrene, necessitating major amputation. The progression from an initial ‘scratch’ to gangrene can take as little as 48 hours. A lack of knowledge and education can lead to a lack of urgency among PwD, carers and HCPs, who may not recognise that they have a foot related problem requiring urgent referral or care interventions. If there are difficulties in accessing a HCP appointment, there is a risk of critical delay in PwD receiving appropriate assessment and treatment. ACT NOW is designed to promote timely referral and save limbs. iDEAL seeks to reduce amputations by 50% in 5 years by encouraging people to use ACT NOW. Prompt assessment and early referral can help reduce this unnecessary suffering. ACT NOW also seeks to reduce stigma often experienced by PwD regarding complications and remove any blame or shame associated with diabetes complications. These changes can be created through encouraging and enabling an environment of education, knowledge and trust using language that enables PwD.

Summary and Conclusion

Diabetes is a multifactorial disease process, and its long-term management requires the active involvement of people with diabetes and their families, as well as a large multidisciplinary care team to ensure optimal health, quality of life, and productivity. Keeping up with new medications, emerging technology, and evolving treatment recommendations can be challenging, and the language and care processes commonly used by practitioners in one discipline may be less familiar to other diabetes care professionals.

Abstract #1088588: The Impact of a Prolonged Lockdown and Utilization of a Simplified Diabetes Telemedicine Clinic on Cardiometabolic Health in People With Diabetes During The COVID-19 Outbreak in Saudi Arabia

To mitigate the spread of COVID-19, Saudi Arabia (SA) implemented strict precautionary measures including a prolonged nationwide lockdown that lasted for approximately 3 months. Due to the limited availability of telemedicine and cancellation of routine in-person visits, many people with diabetes (PWD) in SA lost access to their diabetes care professionals. Here, we examined the impact of lockdown on cardiometabolic health in PWD and how this may have differed between those who utilized a simplified diabetes telemedicine clinic during lockdown versus those who did not.

The challenges of managing diabetes while homeless: a qualitative study using photovoice methodology

BACKGROUND:Minimal consideration has been given to understanding the challenges of managing diabetes while homeless from the perspective of those with lived or living experience. We used a community-based participatory approach to explore these challenges.METHODS:We recruited coresearchers with experiential knowledge of both homelessness and diabetes. Lead researchers conducted research training and facilitated research development by coresearchers. Coresearchers collectively chose to use photovoice methodology to illustrate the challenges of accessing healthy food while homeless and to explore how homelessness more broadly affects diabetes management. After training in photography technique and ethics, coresearchers took photos to address these objectives and created accompanying narratives using photo elicitation techniques. Lead researchers analyzed photos and narratives, and extracted themes, refined through group discussion.RESULTS:The 8 coresearchers had type 2 diabetes (diagnosed 18 months to 23 years previously) and had experienced homelessness for periods ranging from 8 months to 12 years. We identified 4 themes from the 17 photos and narratives they produced. Homelessness imposed major demands on emotional and mental health, impairing the ability of those affected to focus on diabetes self-management. Foods provided in shelters were often nutritionally poor or unpalatable. Obtaining housing facilitated diabetes management through stability and autonomy, but cost and lack of knowledge posed challenges to healthy food preparation. Homelessness also presented challenges to accessing diabetes care professionals and prescription medications.INTERPRETATION:The images and narratives provide a powerful firsthand, in-depth account of the challenges faced by people trying to manage diabetes while homeless. Understanding these challenges is the first step in enabling providers and policy-makers to meet the needs of this population.

Providing diabetes education to patients with chronic kidney disease: A survey of diabetes educators in Ontario, Canada.

BackgroundPatients with diabetes and chronic kidney disease (CKD) have complex diabetes care needs. Diabetes educators can play an important role in their clinical care.AimTo understand diabetes educators’ experience providing diabetes support to patients with CKD and elicit their view on the additional care needs of this population.MethodsWe conducted a quantitative online survey of diabetes educators between May 2019 and May 2020. We surveyed English-speaking educators actively practicing in Ontario, Canada for at least 1 year. We recruited them through provincial Diabetes Education Programs and Diabetes Education Section Chairs of Diabetes Canada.ResultsWe made email contact with 219/233 (94%) Diabetes Education Programs and 11/12 (92%) provincial Diabetes Canada Section Chairs. 122 unique diabetes educators submitted complete surveys (survey participation rate ∼79%). Most worked in community education programs (91%). Almost half were registered nurses (48%), and 39% had practiced for more than 15 years. Respondents noted difficulty helping patients balance complex medical conditions (19%), faced socioeconomic barriers (17%), and struggled to provide dietary advice (16%). One-third were uncertain of how to support those receiving dialysis. Eighty-five percent felt they needed more training and education to care for this high-risk group. When asked about the care needs of patients with CKD, almost all (90%) felt that patients needed more diabetes support in general. Improvement in care coordination was most commonly suggested (38%).ConclusionsIn this study of the diabetes educators’ experience treating patients with diabetes and CKD, respondents noted numerous challenges. There may be opportunities to better support both diabetes care professionals, and patients who live with multiple medical comorbidities.

A diabetes specialist nurse audit within NHS England

AbstractThe diabetes specialist nurse (DSN) works wholly in diabetes care and plays an integral part in diabetes multidisciplinary teams; the benefits of the role are well recognised. The post emerged in the 1950s and it was designed to support both people living with diabetes and health care professionals not working in specialist teams. Previous audits of DSNs indicated that the numbers of nurses working in this role were reducing and concerns were raised at national level about how this might impact on the care of an ever expanding population with diabetes. This audit through a ‘Freedom of Information’ request has identified many more DSNs than previous audits. It has also demonstrated a plethora of different job titles, whether most were employed in hospital or in primary care, and their banding. This audit has prompted the need for other information gathering and investigation which will aid workforce development. Copyright © 2020 John Wiley &amp; Sons.

Understanding the experiences of long-term maintenance of self-worth in persons with type 2 diabetes in Japan: a qualitative study

ObjectivePersons with type 2 diabetes are often stigmatised for having what is considered a lifestyle-related disease. Accordingly, some blame themselves for their condition, resulting in feelings of low self-worth that...

The Unmet Medical Needs of Current Injectable Antidiabetic Therapies in China: Patient and Health Care Professional Perspectives

PurposePatients with diabetes and health care professionals (HCPs) play important roles in effective application of injectable antidiabetic therapies (IATs). However, their concerns and opinions on IATs are rarely investigated in China. This study aims to assess unmet medical needs of IATs regarding patient concerns, patient satisfaction, aspects that need improvement, and training burden from patient and HCP perspectives. MethodsThis cross-sectional survey was conducted in 12 representative Chinese cities from December 2018 to January 2019. Patients with adult type 2 diabetes who were receiving IAT currently and had received IAT continuously for at least 1 month before the survey, endocrinologists with ≥5 years of experience and prescribing IAT in the past 1 month, and nurses with ≥3 years of experience and providing IAT training in the past 1 month were eligible participants. The patient survey assessed concerns of initiating IAT, satisfaction with IAT, aspects of IAT that need improvement, and IAT training received. The HCP survey evaluated patient concern of initiating IAT, aspects of IAT that need improvement, experience of providing IAT training, and self-reported burden of training. Descriptive statistical analysis was performed. FindingsIn total, 500 patients, 200 endocrinologists, and 100 nurses were surveyed. The mean (SD) age of patients was 55.1 (11.8) years, with a disease duration of 7.6 (6.4) years. Of all patients, 391 (78.2%) were insulin users and 109 (21.8%) were glucagon-like peptide 1 receptor agonist users. Of the top 4 concerns about initiating IAT, both patients and endocrinologists reported inconvenience of daily injection (58.0% of patients and 68.5% of endocrinologists), worries about insulin dependence (42.6% of patients and 62.5% of endocrinologists), and fear of injection (37.0% of patients and 66.5% of endocrinologists). Medical expenses, convenience of drug portability and storage, and injection site reactions were the top 3 aspects that need improvement according to both patients and HCPs. High injection frequency was also one of the most urgent aspects for improvement (mean urgency score, 3.8 for physicians and 4.0 for nurses). A typical IAT training session took a mean (SD) of 14.1 (9.7) minutes. Both patients and HCPs considered injection operation after dose is set and symptoms and treatment for adverse effects as the 2 most time-consuming training contents. In addition, 97.1% of endocrinologists who provided training and 97.0% of nurses thought a more user-friendly IAT would reduce their training burden. ImplicationsStudy results indicate that the IATs with more convenient drug portability and storage, fewer injection site reactions and adverse events, less injection frequency, more user-friendly design, and fewer steps for injection might help improve patient experience with self-injection and reduce HCPs’ training burden.

Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation

BackgroundInternationally, systematic screening for sight-threatening diabetic retinopathy (STDR) usually includes annual recall. Researchers and policy-makers support extending screening intervals, citing evidence from observational studies with low incidence rates. However, there is little research around the acceptability to people with diabetes (PWD) and health care professionals (HCP) about changing eye screening intervals.MethodsWe conducted a qualitative study to explore issues surrounding acceptability and the barriers and enablers for changing from annual screening, using in-depth, semistructured interviews analysed using the constant comparative method. PWD were recruited from general practices and HCP from eye screening networks and related specialties in North West England using purposive sampling. Interviews were conducted prior to the commencement of and during a randomised controlled trial (RCT) comparing fixed annual with variable (6, 12 or 24 month) interval risk-based screening.ResultsThirty PWD and 21 HCP participants were interviewed prior to and 30 PWD during the parallel RCT. The data suggests that a move to variable screening intervals was generally acceptable in principle, though highlighted significant concerns and challenges to successful implementation. The current annual interval was recognised as unsustainable against a backdrop of increasing diabetes prevalence. There were important caveats attached to acceptability and a need for clear safeguards around: the safety and reliability of calculating screening intervals, capturing all PWD, referral into screening of PWD with diabetic changes regardless of planned interval. For PWD the 6-month interval was perceived positively as medical reassurance, and the 12-month seen as usual treatment. Concerns were expressed by many HCP and PWD that a 2-year interval was too lengthy and was risky for detecting STDR. There were also concerns about a negative effect upon PWD care and increasing non-attendance rates. Amongst PWD, there was considerable conflation and misunderstanding about different eye-related appointments within the health care system.ConclusionsImplementing variable-interval screening into clinical practice is generally acceptable to PWD and HCP with important caveats, and misconceptions must be addressed. Clear safeguards against increasing non-attendance, loss of diabetes control and alternative referral pathways are required. For risk calculation systems to be safe, reliable monitoring and clear communication is required.